老年患者全髋关节置换术后携带利多卡因局部镇痛泵的疗效

The effectiveness of continuous local infiltration of lidocaine after total hip arthroplasty in the elderly

[目的]探讨携带利多卡因局部镇痛泵在全髋关节置换术后镇痛中的疗效。[方法]将60岁以上初次全髋关节置换病例分为两组,一组术后伤口放置局部镇痛泵持续缓释利多卡因(局部镇痛泵组),一组术后使用静脉镇痛泵(patient controlled intra-venous analgesia,PCIA)输入稀释芬太尼(PCIA组)。比较两组术后静息疼痛视觉模拟评分(visual analogue scale,VAS);伤口延期愈合率、感染率;头晕、恶心、呕吐、尿潴留发生率;镇痛泵依从性比率。[结果]局部镇痛泵组术后1h VAS评分高于静脉镇痛泵组(P=0.016),术后2 h VAS评分与PCIA组相比差异无统计学意义(P=0.510),局部浸润组术后24 h(P=0.024)、48 h(P=0.012)VAS评分低于静脉镇痛组,差异有统计学意义。术后3 h后局部镇痛泵组应用额外镇痛药比例低于PCIA组(P=0.015),局部镇痛泵者依从性优于PCIA组(P<0.001)。局部镇痛组术后头晕、恶心、呕吐、尿潴留发生率均低于静脉镇痛组,差异有统计学意义;伤口延期愈合率两组差异无统计学意义;两组均无伤口感染。[结论]对于老年全髋关节置换患者,局部镇痛泵持续静息镇痛效果优于PCIA泵,能明显减少患者头晕、恶心、呕吐、尿潴留发生率;全身麻醉患者,局部镇痛泵应用时如果配合术中伤口局部浸润麻醉或者术后早期辅助额外小剂量镇痛药物镇痛效果可能更加理想。

[Objective]To discuss the effectiveness of continuous local infiltration of lidocaine after total hip arthroplasty（THA） in the elderly.[Method]From Aug 2013 to May 2014,95 patients（more than 60 years old） for primary THA were divided into two group according to the way of postoperative analgesia,i.e.the local infiltration analgesia（LIA） group with continuous local infiltration of lidocaine and the patient controlled intra-venous analgesia（PCIA） group with fentanyl.The visual analogue scale（VAS） scores were recorded postoperatively.The wound healing and infection,urine retention,nausea,vomiting,dizziness and compliance of analgesia pump were compared.[Result]The VAS score of LIA group was higher than those of PCIA group at 1 hours after operation（P = 0.016）.There was no significant difference of the VAS scores between two groups at 3hours after operation（P = 0.510）.However,the VAS scores of LIA group were lower than that of PCIA group at 24 h（P = 0.024） and 48 h（P = 0.012） after operation.The incidences of dizziness,nausea,vomiting,and urine retention of PCIA group were higher than those of LIA group.There was no significant difference in wound healing between two groups.There were no infection of wound in both groups.The compliance of analgesia pump in LIA group is better than that of PCIA group.[Conclusion]For the elderly with THA,the effectiveness of continuous local infiltration of lidocaine is better than that of PCIA,which reduces the incidences of dizziness,nausea,vomiting and urine retention.